Polimedicación, prescripción inapropiada y eventos adversos a fármacos en ancianos hospitalizados: un problema de seguridad del paciente / Polymedication, inappropriate prescription and adverse events to drugs in hospitalized elderly: a patient safety problem / Polimedicação, prescrição inadequada e eventos adversos a medicamentos em idosos hospitalizados: um problema para a segurança do paciente

RESUMEN Introducción: La esperanza de vida ha ido en aumento y la posibilidad de padecer una o más patologías crónicas, por ejemplo, diabetes mellitus, hipertensión arterial, etc. es alta. La respuesta a los medicamentos en los adultos mayores es marcadamente diferente que en los adultos no ancianos pues se trata de un organismo donde las consecuencias directas del envejecimiento son de relevancia (reducción de la capacidad metabólica del hígado, reducción de la capacidad de filtrado del riñón, hipoclorhidria, entre otros). Objetivo: Analizar la polifarmacia, la prescripción inapropiada y los eventos adversos en adultos mayores hospitalizados. Materiales y métodos: Estudio descriptivo de corte transversal. Resultados: Se estudiaron 318 pacientes. La frecuencia de pacientes polimedicados fue 89 % (283). La prescripción inapropiada, 18,9 %. Los fármacos mayormente presentes en los esquemas de pacientes polimedicados fueron benzodiacepinas, AINEs, anticoagulantes y antihipertensivos. Los pacientes con eventos adversos han sido 179 (56,3 %), de ese porcentaje un 30,2 % (54) ha recibido tratamiento con otro medicamento para resolver el evento producido por un medicamento, eso es la llamada cascada de prescripción o de medicamentos. Conclusiones: La polimedicación es alta y causa eventos adversos, es necesario insistir en el trabajo integral para reducir este problema sanitario.

SUMMARY Introduction: Life expectancy has been increasing and the possibility of suffering from one or more chronic pathologies, for example, diabetes mellitus, arterial hypertension, etc. is high. The response to medications in older adults is markedly different than in non-elderly adults since it is an organism where the direct consequences of aging are relevant (reduction of the metabolic capacity of the liver, reduction of the filtering capacity of the kidney, hypochlorhydria, among others). Objective: To analyze polypharmacy, inappropriate prescription, and adverse events in hospitalized older adults. Materials and methods: Descriptive cross-sectional study. Results: 318 patients were studied. The frequency of polymedicated patients was 89 % (283). Inappropriate prescription, 18.9 %. The drugs most present in the regimens of polymedicated patients were benzodiazepines, NSAIDs, anticoagulants and antihypertensives. Patients with adverse events have been 179 (56.3 %), of that percentage 30.2 % (54) have received treatment with another drug to resolve the event produced by a drug, which is the so-called prescription or prescription cascade. Conclusions: Polypharmacy is high and causes adverse events, it is necessary to insist on comprehensive work to reduce this health problem.

RESUMO Introdução: A expectativa de vida vem aumentando e a possibilidade de sofrer de uma ou mais patologias crónicas, como por exemplo, diabetes mellitus, hipertensão arterial etc. é alta. A resposta aos medicamentos em idosos é marcadamente diferente da de adultos não idosos, pois é um organismo onde as consequências diretas do envelhecimento são relevantes (redução da capacidade metabólica do fígado, redução da capacidade de filtragem do rim, hipocloridria, entre outros). Objetivo: Analisar polifarmácia, prescrição inadequada e eventos adversos em idosos hospitalizados. Materiais e métodos: Estudo transversal descritivo. Resultados: 318 pacientes foram estudados. A frequência de pacientes polimedicados foi de 89% (283). Prescrição inadequada, 18,9%. Os medicamentos mais presentes nos esquemas dos pacientes polimedicados foram benzodiazepínicos, AINEs, anticoagulantes e anti--hipertensivos. Os pacientes com eventos adversos foram 179 (56,3%), desse percentual 30,2% (54) receberam tratamento com outro medicamento para resolução do evento produzido por um medicamento, que é a chamada prescrição ou receita em cascata. Conclusões: A polifarmácia é elevada e causa eventos adversos, é necessário insistir em um trabalho abrangente para reduzir esse problema de saúde.

Polifarmacia y complejidad farmacoterapéutica en pacientes de hogares de ancianos en Cienfuegos / Polypharmacy and pharmacotherapeutic complexity in patients from nursing homes in Cienfuegos

Introducción: Revisar la prescripción representa una oportunidad para corregir errores y optimizar la farmacoterapia en grupos vulnerables. Objetivos: Analizar la complejidad farmacoterapéutica que se presenta en el paciente polimedicado del medio residencial. Material y Métodos: Estudio descriptivo, retrospectivo y transversal; de esquema terapéutico con elementos de indicación-prescripción. Universo: 117 historias clínicas de pacientes polimedicados con 60 años y más que residen en los hogares de ancianos. Período: junio-julio del 2020. Escenario: todos los hogares de ancianos en Cienfuegos, Cuba. Variable dependiente: complejidad farmacoterapéutica definida por la presencia de tres o más de los indicadores de calidad de vida medidos por la evaluación geriátrica exhaustiva, Escala de Puntuación Acumulativa de Enfermedad en Geriatría y criterios STOPP/START. Variables independientes: edad, sexo, enfermedad relacionada al mayor consumo de medicamentos, validismo, comorbilidad, tipo de prescripción, medicamentos inadecuados. Fuente: historia clínica individual. Resultados: La complejidad farmacoterapéutica en los polimedicados se detectó en el 76,9 por ciento de los prescritos inadecuadamente, con multimorbilidad (OR=17,3; IC95 por ciento:16-18,6), dependientes funcionales (OR=9,9; IC95 por ciento:6,8-13) y ancianos ≥75 años (OR=5,1; IC95 por ciento:4-6,2). Las benzodiacepinas fue el grupo más prescrito inadecuadamente. Los antiagregantes plaquetarios y las estatinas son los medicamentos indicados no prescritos. Conclusiones: Los ancianos polimedicados del medio residencial tienen prescripciones de grupos/fármacos de uso frecuente que se relacionan con errores de prescripción, que expone polifarmacia inadecuada y complejidad farmacoterapéutica con posible amenaza a la calidad de vida del geronte institucionalizado(AU)

Introduction: Reviewing the prescription represents an opportunity to correct errors and to optimize pharmacotherapy in vulnerable groups. Objectives: To analyze the pharmacotherapeutic complexity that occurs in the polymedicated patients living in the residential environment. Material and Methods: Descriptive, retrospective and cross-sectional study of therapeutic scheme with indication-prescription elements. Universe: 117 medical records of polymedicated patients aged 60 years and over who reside in nursing homes. Period: June-July 2020. Scenario: all nursing homes in Cienfuegos, Cuba. Dependent variable: pharmacotherapeutic complexity defined by the presence of three or more indicators of the quality of life measured by the exhaustive geriatric assessment, the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and the STOPP/START criteria. Independent variables: age, sex, disease related to increased drug use, validity, comorbidity, type of prescription, inappropriate medications. Source: individual medical history. Results: Pharmacotherapeutic complexity in polymedicated elderly was identified in 76.9 percent of those inappropriately prescribed, multimorbid (OR = 17.3; 95 percent CI: 16-18.6), functionally dependent (OR = 9.9; 95 percent: 6.8 -13) and elderly people ≥75 years (OR = 5.1; 95 percent CI: 4-6.2). Benzodiazepines were the most inappropriately prescribed group. Antiplatelet agents and statins are the indicated non-prescription drugs. Conclusions: Polymedicated elderly patients living in the residential environment follow prescriptions of frequently used groups/drugs which are related to prescription errors with exposure to inadequate polypharmacy and pharmacotherapeutic complexity with a possible threat to the quality of life of the institutionalized elderly people(AU)

Criterios STOPP-START y la prescripción inapropiada del anciano / STOPP/START criteria and inappropriate prescription in the elderly

Introducción: El envejecimiento no solo promueve daños moleculares y celulares con deterioro progresivo de las funciones del cuerpo, sino que este proceso trasciende a los tratamientos y predispone a las prescripciones potencialmente inapropiadas y a la polifarmacia. Esta situación complejiza la atención del anciano con mayor utilización de servicios sanitarios y gastos en medicamentos. Objetivo: Identificar posibles prescripciones potencialmente inapropiadas y estimar la influencia de factores biomédicos en la polifarmacia de los ancianos hospitalizados. Material y Métodos: Investigación cuasi-experimental estudio antes-después, que acopió información de variables biomédicas de las historias clínicas de 200 pacientes hospitalizados en el Centro de Investigaciones sobre Longevidad, Envejecimiento y Salud, se utilizaron los criterios STOPP-START para identificar prescripciones potencialmente inapropiadas; se realizaron pruebas para estadística descriptiva e inferencial (α=0,05). Resultados: Se identificaron al ingreso 349 prescripciones inapropiadas STOPP y 357 prescripciones inapropiadas START, la sección correspondiente al sistema nervioso central aportó el 24,8 por ciento de las prescripciones inapropiadas STOPP y el sistema cardiovascular reveló el 59,9 por ciento de las prescripciones inapropiadas START. La polifarmacia estuvo presente en el 43,0 por ciento de los ancianos y la comorbilidad fue la variable que mostró mayor fuerza de asociación con la polifarmacia (OR =8,65; IC-95 por ciento: 4,51-16,59), seguido por la presencia de dos o más prescripciones inapropiadas según los criterios STOPP. Conclusiones: Los criterios STOPP-START identifican prescripciones inapropiadas en el contexto sanitario cubano, todo lo cual impacta de forma negativa en la polifarmacia de los ancianos. El sistema nervioso central y el sistema cardiovascular mostraron el mayor número de prescripciones potencialmente inapropiadas(AU)

Introduction: Aging not only promotes molecular and cellular damage with progressive deterioration of body functions, but this process transcends treatments and predisposes to potentially inappropriate prescriptions and polypharmacy. This situation complicates the care of the elderly with greater use of health services and drug expenses. Objective: To identify possible potentially inappropriate prescriptions and estimate the influence of biomedical factors on polypharmacy in hospitalized elderly people. Material and Methods: Quasi-experimental before-after study which collected information on biomedical variables from the medical records of 200 hospitalized patients at the Longevity, Aging and Health Research Center. The STOPP/START criteria were used to identify potentially inappropriate prescriptions. Descriptive and inferential statistical tests were performed (α = 0.05). Results: A total of 349 inappropriate STOPP prescriptions and 357 inappropriate START prescriptions were identified upon admission. The section corresponding to the central nervous system contributed 24.8 percent of the inappropriate STOPP prescriptions and the cardiovascular system revealed 59.9 percent of the inappropriate START prescriptions. Polypharmacy was present in 43.0 percent of the elderly and comorbidity was the variable that showed the greatest strength of association with polypharmacy (OR = 8.65; 95 percent CI: 4.51-16.59), followed by the presence of two or more inappropriate prescriptions according to the STOPP criteria. Conclusions: The STOPP/START criteria identify inappropriate prescriptions in the Cuban healthcare context which has a negative impact on polypharmacy in the elderly. The central nervous system and the cardiovascular system showed the highest number of potentially inappropriate prescriptions(AU)

Optimizando farmacoterapia mediante la deprescripción: reporte de caso / Optimizing pharmacotherapy through deprescription: Case report

RESUMEN La polifarmacia es el uso simultáneo o excesivo de varios medicamentos y ha presentado una tendencia al aumento durante los últimos años, al igual que los cuadros clínicos asociados a interacciones farmacológicas secundarias, llevando así a adicionar cada vez más medicamentos, esto genera el fenómeno de cascada en la prescripción. En este artículo se presenta un caso de una mujer de 34 años, identificado desde una plataforma transaccional de registro de medicamentos prescritos de una EPS, a quien se realizó seguimiento de su tratamiento farmacológico ambulatorio durante 7 meses, en los cuales presentó persistencia de polifarmacia. Se identificó en el caso posibles errores en medicación y posibles ajustes a la terapia que disminuirían el riesgo de interacciones o cascada de prescripción.

SUMMARY Polypharmacy is the simultaneous use or excess of dosage of medicines and it has shown a tendency to increase in recent years, as well as the clinical symptoms associated with secondary drug interactions, thus leading to the addition of more and more medications, generating the cascade phenomenon of prescription. We present a case of a 34-year-old woman, identified from a transactional platform of registration of prescribed drugs of an EPS, who was followed up on her outpatient pharmacological treatment for 7 months, in which she presented persistent polypharmacy. It was identified in the case possible errors in medication and possible adjustments to the therapy that would decrease the risk of interactions or prescription cascade.

Polifarmacia en México: un reto para la calidad en la prescripción / Polypharmacy in Mexico: a challenge for prescription quality

Resumen: Objetivo: Analizar la prevalencia de polifarmacia, así como los factores que identifican a los grupos con mayor riesgo, en un estudio poblacional en México. Material y métodos: Análisis descriptivo de la Encuesta Nacional de Salud y Nutrición 2018-19 (Ensanut 2018-19), cuestionarios de Utilización de servicios (sección medicamentos) y del Hogar, para obtener la prevalencia de polifarmacia (consumo simultáneo ≥5 medicamentos). Se utilizó un modelo de regresión logística para estimar la asociación de polifarmacia con factores sociodemográficos y de atención a la salud. Resultados: Prevalencia de polifarmacia: ≥18 años, 15.5%, y ≥65 años, 26.5%. Prevalencias superiores: nefropatías (61.5%), cardiopatías (42.2%), enfermedad pulmonar obstructiva crónica (38.5%), diabetes (29.3%) e hipertensión (26.4%). Mayor posibilidad en adultos ≥65 años (OR:1.95), con baja escolaridad (OR:1.54), seguridad social (OR:1.64), atendidos en servicios públicos (OR:1.7) y enfermedad crónica (OR:1.84). Conclusiones: La polifarmacia se asocia con tener enfermedad crónica y con factores sociodemográficos. Es una gran área de oportunidad para mejorar calidad de la atención, particularmente la prescripción farmacológica a la población identificada con mayor riesgo.

Abstract: Objective: To analyze the prevalence of polypharmacy, as well as the factors that identify the groups with higher risk, in population study in Mexico. Materials and Methods: Descriptive analysis of the Encuesta Nacional de Salud y Nutrición 2018-19 (Ensanut 2018-19), Utilization of services (medicine section) and Household questionnaires, to obtain prevalence of polypharmacy (simultaneous consumption ≥5 medicines). A logistic regression model was used to estimate the association of polypharmacy with sociodemographic and health care factors. Results: Prevalence of polypharmacy: 18 years, 15.5%, and 65 years, 26.5%. Higher prevalence in: nephropathies (61.5%), heart disease (42.2%), chronic obstructive pulmonary disease (38.5%), diabetes (29.3%) and hypertension (26.4%). Increased possibility in adults 65 years (OR:1.95), low schooling (OR:1.54), social security (OR:1.64), serviced in public services (OR:1.7) and chronic illness (OR:1.84). Conclusions: Polypharmacy is associated with chronic disease and some sociodemographic factors. Large area of opportunity to improve quality of care, particularly pharmacological prescription to identified population with higher risk.

Uso de medicamentos potencialmente inapropriados entre idosos institucionalizados: um estudo longitudinal / Use of potentially inappropriate medications among institutionalized elderly people: a longitudinal study

O presente trabalho tem como objetivos verificar a prevalência do uso de medicamento potencialmente inapropriado (MPI) para idosos residentes em instituições de longa permanência (ILPI) e os fatores associados, assim como avaliar as mudanças na ocorrência de MPI ao longo do tempo. A primeira etapa do estudo (Estudo 1) segue delineamento transversal e utilizou dados da linha de base do estudo "Envelhecimento Humano e Saúde: a realidade dos idosos institucionalizados na cidade do Natal/RN", que tem como objetivo avaliar as condições de saúde/doença dos idosos institucionalizados da cidade do Natal/RN. A coleta foi realizada com base nos dados coletados em 10 ILPI no município de Natal, RN. Os medicamentos inapropriados foram classificados de acordo com o Critério da American Geriatric Society (AGS)/Beers 2015. Foram analisadas variáveis sociodemográficas, relacionadas à ILPI e às condições de saúde. Para as análises univariada e multivariada entre a variável dependente (uso de pelo menos 1 MPI) e as variáveis independentes foi utilizada a regressão de Poisson com estimador robusto. A amostra do estudo foi composta por 321 idosos, sendo identificada a prevalência de 54,6% (IC95%: 48,9- 60,2) de utilização de MPI. A análise multivariada revelou que o uso de MPI esteve associado à polifarmácia e à demência e os grupos de MPI mais frequentes foram antispicóticos (39,1%), os benzodiazepínicos (30,7%) e as sulfoniluréias (7,6%). A segunda parte do estudo (Estudo 2), seguiu delineamento longitudinal de 24 meses de acompanhamento com intervalos de follow-up de 6 meses (ondas). Foram mantidas as variáveis e o critério da AGS/Beers adotados no Estudo 1. A prevalência de uso de MPI foi elevada nas 4 ondas, sendo, repectivamente: 63,4% (IC95%: 57,6-69,1) na onda 1, 62,9% (IC95%: 56,8-68,9) na onda 2, 69,2% (IC95%: 63,1-75,3) na onda 3 e 65,9% (IC95%:59,4-72,4) na onda 4. Foi observado, no período, o aumento do uso de MPI e da polifarmácia. Entre as classes de MPI analisados, os antipscicóticos, os benzodiazepínicos e os inibidores da bomba de prótons foram os mais frequentemente identificados em todas as ondas. O estudo revelou a manutenção da alta prevalência de MPI entre os idosos das ILPI, configurando a necessidade de adoção de indicadores do uso destes medicamentos e a implantação de estratégias que tornem a farmacoterapia mais segura e adequada aos idosos (AU).

The main obectives of this work were to verify the prevalence of Potentially Inappropriate Medication (PIM) use amog older people living in long term instituition and associated factors, as well as to evaluate the changes in the occurrence of PIM use over time. The first stage of the study (Study 1) follows a cross-sectional design and used baseline data from the study "Human Aging and Health: the reality of the institutionalized elderly in the city of Natal/RN", which aims to assess health/institutionalized elderly in the city of Natal/RN. The collection was performed based on the data collected in 10 Long Term Care (LTC) in the city of Natal, RN. Inappropriate medications were classified according to the 2015 American Geriatric Society (AGS) Beers Criteria for Potentially Inappropriate Medication Use in Older Adults - 2015. Sociodemographic variables, related to LTC and health conditions, were analyzed. For the univariate and multivariate analyzes between the main variable (use of one or more PIM according to the 2015 AGS/Beers criteria ) and the other variables, the Poisson regression was used with a robust estimator. The study population consisted of 321 elderly people, of whom 304 used medications, and the prevalence of PIM was 54.6% (95% CI: 48.9-60.2). Multivariate analysis revealed that PIM was associated with polypharmacy and dementia, and the most frequent PIM groups were antipsychotic, benzodiazepine and sulfonylureas. The second part of the study (Study 2) followed a 24- month longitudinal follow-up with 6-month follow-up intervals (waves). The variables and the AGS/Beers criteria adopted in Study 1 were maintained. The prevalence of PIM use was high in the 4 waves, and 63.4% (95% CI: 57,6-69,1) in the wave 1, 62.9% (95% CI: 56.8- 68.9) in wave 2, 69.2% (95% CI: 63.1-75.3) in wave 3 and 65.9% (95% CI: 59.4-72.4) in wave 4. Among the PIM classes analyzed, antipsychotics (39,1%), benzodiazepines (30,7%) and proton pump inhibitors (7,6%) were the most frequently identified in all waves. The study revealed the maintenance of the high prevalence of PIM among the elderly of the LTC, setting the need to adopt indicators on the use of these medicines and the implementation of strategies that make pharmacotherapy safer and more adequate for older adults (AU).

Prescripción inapropiada en adultos mayores hospitalizados / Inappropriate prescription in elderly inpatients

Una de las causas prevenibles de los eventos adversos a medicamentos (EAM) en la población adulta mayor es la prescripción inapropiada, (PIM), es decir aquella prescripción donde los riesgos superan los beneficios clínicos. Se propone conocer la incidencia de PIM con los criterios de Beers, los Screening tool of older person´s prescriptions (STOPP), la omisión de prescripción apropiada (PPO) con Screening tool to alert doctors to right treatment (START) y los costos medios de hospitalización. Es un estudio de incidencia de una muestra de pacientes > 64 años, internados en el periodo enero-julio 2014 en un hospital universitario. Se halló una incidencia de PIM de 61.4% con los criterios de Beers, 65.4% con STOPP y 27.6% de PPO con START. Se calculó una tasa de EAM de 15.2 EAM/100 admisiones y 18.6 EAM/1000 días paciente. El OR de EAM con PIM según Beers y STOPP fue 1.49 (IC95% 1.68-4.66) y 1.17 (IC95% 0.62-2.24) respectivamente. El costo de hospitalización en pacientes con EAM fue mayor que sin EAM (p = 0.020). Los resultados de PIM son similares a la mayoría de los estudios publicados, aunque levemente mayores para Beers y STOPP y menores para START. La tasa de EAM es inferior a la encontrada por Kanaan (18.7% vs. 15.2%). Hay una contribución de PIM a la aparición de EAM.

One of the causes of preventable adverse drug events (EAM) in the older adult population is the inappropriate prescription (PIM), i.e. that prescription where risks outweigh clinical benefits. The aim of this study is to determine the incidence of PIM with Beers criteria and Screening Tool of older person´s prescriptions (STOPP), Potentially Prescribing Omissions (PPO) with Screening Tool to alert doctors to Right Treatments (START), and the average costs of hospitalization. This is an incidence study on a sample of patients over 64 years hospitalized, from January to July 2014 at a university hospital. According to Beers criteria, PIM incidence was 61.4%, 65.4% with STOPP and 27.6% PPO with START. The EAM rate calculated was 15.2/100 admissions and 18.6 EAM / 1000 patient days. The OR of EAM with PIM according to Beers and STOPP was 1.49 (IC95% 1.68-4.66) and 1.17 (IC95% 0.62-2.24) respectively. The average cost of hospitalization in patients with EAM were higher than without EAM (p = 0.020). PIM results are in line with most of the studies cited, but slightly higher for Beers and STOPP and lower for START, and the rate of EAM is lower than the data found by Kanaan (18.7% vs. 15.2%). PIM contributes to the appearance of EAM. The costs of hospitalizations with EAM are higher than those without EAM, achieving level of significance.

Analysis of clinical effect of involvement of clinical pharmacists in perioperative total parenteral nutrition prescription for cancer patients / 中华临床营养杂志

Objective To evaluate the effect of the intervention of involving clinical pharmacists in perioperative total parenteral nutrition (TPN) prescription,including rationality of prescriptions,the length of hospital stay and economic evaluation.Methods We respectively selected TPN prescriptions in September to November 2015 (pre-intervention) and December 2015 to February 2016 (post-intervention) from a surgery department of Harbin Medical University Cancer Hospital.The data regarding rationality of prescription,length of hospital stay,and economic benefit were analyzed in order to evaluate the effect of involvement of clinical pharmacists in TPN prescriptions.Results A total of 81 patients with 115 TPN prescriptions before the intervention and 92 patients with 124 TPN prescriptions after the intervention were recruited.Through comparative analysis,the rationality of TPN prescriptions increased significantly after the participation of clinical pharmacists in terms of the rational glucose:fat ratio,energy:nitrogen ratio,electrolyte concentration,and the choice of vitamin preparations;and the utilization of controversial treatments such as invert sugar and other drugs into readyto-use TPN solution was decreased significantly;average daily cost of TPN was decreased from (1 021 ± 218) yuan to (860 ± 176) yuan (P ＜0.001);average duration of hospital stays was decreased but the difference was not statistically significant (P ＞ 0.05).Compared with the data before the intervention,serum albumin levels after the intervention showed no statistically significant difference but pre-albumin levels were significantly higher after the participation of clinical pharmacists [(175.0 ± 77.9) g/L vs.(153.2 ± 64.8) g/L,P ＜ 0.05].The liver and kidney function indicators showed no statistically significant differences between pre-and post-intervention (P ＞ 0.05).Conclusion Engaging clinical pharmacists in TPN prescription can improve prescription rationality,ensure clinical drug safety,reduce the daily cost of nutrition treatment and thus reduce the economic burden of patients.

Uso de hierro en forma de medicamento en gestantes colombianas / Pregnant Colombian females' iron in take in drug form

Objetivo Caracterizar el consumo de hierro en forma de medicamento en un grupo de embarazadas colombianas. Metodología Estudio observacional descriptivo, se obtuvo información de mujeres en control prenatal y/o atención del parto en 4 ciudades de Colombia. Las fuentes de información fueron entrevistas a gestantes y registros de historia clínica. Resultados La muestra fue de 1 637 mujeres en 15 instituciones. A 1 396 mujeres (85,3 %) les recomendaron consumir hierro, recomendación realizada por médico al 85,3 % de ellas, el 86,8 % tuvo adherencia al tratamiento. Al 84,7 % el hierro fue suministrado por la empresa aseguradora de salud, el 11,9 % lo compró a sus expensas. El 90,0 % de gestantes anémicas y el 82,8 % de las no anémicas consumieron hierro en forma de medicamento, en conjunto, en el 37,2 % de las gestantes el consumo de suplencia de hierro fue pertinente (es decir, lo necesitaban, se les recomendó y lo consumieron o no le necesitaban, no se recomendó y/o no lo consumieron). Discusión Se recomienda y se consume hierro independientemente de presentar anemia. Se invita a reflexionar sobre la utilidad de los programas que promueven el consumo masivo de esta sustancia en forma de medicamento durante el embarazo, programas que parecen desconocer las causas fundamentales de los problemas nutricionales que aquejan a la población.

Objective Describing a group of pregnant Colombian females' iron intake, in drug form. Methodology This was an observational descriptive study; information was collected in 4 Colombian cities regarding pregnant females during antenatal control or when giving birth. Information sources consisted of interviews with pregnant women and their clinical records. Results The sample consisted of 1,637 female sat tending 15 institutions. An iron intake was recommended for1, 396 women (85.3 %); a doctor made such recommendation in 85.3 % of cases and adherence was 86.8 %. Health insurance was used by 84.7 % of the females for supplying iron; 11.9 % of them bought it themselves. Iron intake as medication for anemic pregnant females was 90.0 % and 82.8 % in non-anemic ones. Iron intake supply was appropriate in 37.2 % of the pregnant females (i.e. they needed it, someone recommended it for them and they consumed it, or they didn't need it, someone didn't recommend it to them and/or they did not take it). Discussion Iron intake was recommended and consumed regardless of anemia status. The results invite to think on the usefulness of programs promoting the mass intake of iron as a medication during pregnancy. Such programs seem to be unaware of the fundamental causes of people's nutritional problems.

Calidad de prescripción de agentes antimicrobianos en pacientes hospitalizados en servicios clínicos / Quality of antimicrobials prescription in patient admitted in clinical services

Introducción: La resistencia microbiana es considerada un fenómeno emergente en todo el mundo y la calidad de la prescripción de los agentes antimicrobianos constituye un elemento esencial en su control. Objetivo: Determinar la calidad de prescripción de agentes antimicrobianos en pacientes hospitalizados en servicios clínicos. Métodos: Se realizó prevalencia puntual, en el Hospital Clinicoquirúrgico "Joaquín Albarrán" durante el período mayo 2008-febrero 2009, mediante evaluación de los pacientes ingresados durante un día de cada uno de los meses del período de estudio. Se utilizó un instrumento, que fue aplicado por 2 investigadores y en una segunda etapa fueron analizados por expertos en uso de agentes antimicrobianos, que determinaron aquellos con prescripción inadecuada. Se calculó la proporción de uso de agentes antimicrobianos y la proporción de prescripción inadecuada. Resultados: Fueron evaluados 1 175 pacientes de los cuales utilizaron agentes antimicrobianos 456 (38,80 por ciento), reportado de forma inadecuada en 66 pacientes (14,5 por ciento). La causa fundamental de prescripción inadecuada fue el uso cuando no estaba indicado o no era necesario (51 pacientes) y la duración incorrecta del tratamiento (40 pacientes). Identificamos deficiencias en la calidad de prescripción de agentes antimicrobianos en pacientes hospitalizados en servicios clínicos, para cuya solución se requieren intervenciones educacionales y organizacionales

Introduction: The microbial resistance is considered as a worldwide emerging phenomenon and the prescription quality of the antimicrobials is an essential element in its control. Objective: To determine the prescription quality of the antimicrobials in patients admitted in clinical services. Methods: A point prevalence in the "Joaquín Albarrán" Hospital from May, 2008 to February, 2009 was carry out by means of assessment of patients admitted for one day of each of months of the study period. A tool was used applied by two researchers and in a second stage were analyzed by experts in antimicrobials use, determining those with an inappropriate prescription. The use ratio of antimicrobials was estimated as well as the inappropriate prescription ratio. Results: A total of 1 175 patients were assessed, from which 456 used antimicrobials (38,80 percent) reported in an inappropriate way in 66 patients (14,5 percent). The leading cause of inappropriate prescription was its use when it was not prescribed or was not necessary (51 patients) and the wrong length of treatment (40 patients). It was possible to identify deficiencies in antimicrobials prescription quality in patients admitted in the clinical services being necessary educational and organizational interventions